Due to the government shutdown, updates to information on this website may be limited or delayed. State Medicaid and Children’s Health Insurance Programs (CHIP) continue to operate. Continue to work with the programs in your state to access coverage. For more information about government operating status, visit OPM.gov.

U.S. flag

An official website of the United States government

Rate Review and Rate Guides

The managed care regulation requires that states develop valid managed care capitation rates in accordance with generally accepted actuarial principles and practices.

2025-2026 Medicaid Managed Care Rate Development Guide

In August 2025, CMS released the 2025-2026 Medicaid Managed Care Rate Development Guide for states to use when setting capitation rates with respect to any managed care program subject to federal actuarial soundness requirements during rating periods starting between July 1, 2025, and June 30, 2026. The guide provides detail around CMS' expectations of information to be included in actuarial rate certifications, and the guide will be used as a basis for CMS’ review. Please direct any questions related to this guide to MMCratesetting@cms.hhs.gov.

View previous years’ rate-setting guidance: